Health Reform Law Reignites Debate Over Health Worker 'Conscience' Protections

"[L]ittle-noticed provisions" in the health reform law (PL 111-148) have "quietly reignited" a debate over balancing patients' rights to receive care with some health workers' moral and religious objections to certain services and procedures, the Washington Post reports.

Supporters of increased "conscience" protections for health workers argue that the new law "leaves vulnerable" those who oppose abortion, emergency contraception, stem cell research and some end-of-life care. Advocates for patients' rights counter that the legislation favors those who oppose such services and creates new hurdles for women seeking abortions and patients who are dying.

The new law mandates that insurance plans offered through the new state-based insurance exchanges do not "discriminate against any individual health care provider or health care facility because of its unwillingness to provide, pay for, provide coverage of or refer for abortions." The law also prohibits discrimination against individuals opposed to "assisted suicide, euthanasia, or mercy killing." In addition, President Obama signed an executive order affirming that the new law does not negate any previous federal "conscience" protections for health workers.

Renewed Attention on HHS 'Conscience' Rule

The debate has renewed focus on Obama's stated intention to rescind a federal conscience regulation put in place during the George W. Bush administration. The regulation would have increased protections for health workers who refuse to provide care on moral or religious grounds. Shortly after taking office, Obama proposed a new rule that would rescind the regulation, arguing that it could create obstacles to abortion and other reproductive health services.

The health reform debate sidelined a final decision on Obama's proposal, and the outcome is being closely monitored as an example of how the administration will handle related issues stemming from the health reform law, the Post reports.

Jenny Backus, an HHS spokesperson, said, "No matter what decision is made in terms of [the Bush administration's rule], providers will continue to be protected -- as they have been for years -- by the existing conscience-clause statutes that will remain on the books." She added, "Not only are there strong existing protections in current law, but the new health reform law also explicitly demonstrates strong support for the rights of providers and patients."














Jennifer Dalven, director of the American Civil Liberties Union's Reproductive Freedom Project, said, "We are quite concerned about religious liberty, but we think the current law appropriately balances individual religious liberty and patients' need for access to health care." Dalven added, "What some people are seeking are rules that take patients out of the equation."

According to the Post, some abortion-rights advocates are "alarmed" that the bill did not include specific protections for health workers who provide abortion services. As the number of U.S. abortion providers continues to decline -- and violence and protests continue -- some advocates are concerned that the law will lead health plans to exclude physicians willing to perform abortions. They also argue that the law in some ways expands protections for abortion opponents by shielding providers who refuse to refer women to an abortion provider.

Nancy Northup, president of the Center for Reproductive Rights, said that the law contains a "lopsided conscience protection." She added, "In a country where 87% of U.S. counties don't have an abortion provider, where abortion providers are murdered and harassed, you really need protections for those who advocate for both performing and referring for abortions. Not the other way around."

Meanwhile, religious groups argue that the health reform law does not do enough to protect health workers who oppose abortion from discrimination by entities other than health plans, which they claim would permit governments, health facilities and others to compel workers to participate in abortion care.

Some supporters of stronger protections for health workers also argue that the law does not safeguard individuals who object to other aspects of care that the federal government could classify as "essential services," such as contraception, sterilization, genetic testing and in-vitro fertilization.

Matthew Bowman of the Alliance Defense Fund said the law "is thousands of pages of new government power, decision-making and funding." He added, "Any government power over health care can be exercised in a way that discriminates against pro-life health providers, especially when officials already support abortion and opposes enforcement of conscience laws."

Jonathan Imbody, vice president for government relations at the Christian Medical Association, said, "At the end of the day regarding the legislation, a pro-life health care professional is left with a weak and limited conscience provision that doesn't even prohibit discrimination by government and institutions" (Stein, Washington Post, 5/11).


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